NH vote nears on expansion of Medicaid

CONCORD — Senate Republicans on the Finance Committee continue to be skeptical of expanding Medicaid under the Affordable Care Act.

Health and Human Services officials urged the committee to expand the program, which would add about 58,000 people to the rolls of the state-federal health insurance program.

Expanding Medicaid is expected to cost the state more than $27 million, but will bring $2.5 billion into the state through provider payments for health care services, according to figures from HHS.

Senate President Peter Bragdon, R-Milford, questioned if the federal government would live up to its commitment to pay 100 percent of the cost of expansion during the first three years before gradually dropping to 90 percent after seven years in the program.

As a member of the Milford School Board, he said, residents of his town pay more than $1 million a year in costs for special education programs that the federal government promised to pay, but has failed to do so.

“I hope you understand my concern when we talk about billions and billions of dollars,” Bragdon said. “I’m not sure that is a gamble I want to take.”

Department of Health and Human Services Associate Commissioner Katie Dunn assured Bragdon the state could leave the program at any time without penalty if the federal government changes the parameters.

She said if the state does not expand Medicaid, thousands of state residents will not have health insurance and the money will go elsewhere.

HHS commissioner Nick Toumpas and Dunn told the committee that Medicaid managed care and Medicaid expansion along with the individual insurance mandates in the Affordable Care Act are tied together and are not separate.

Dunn explained that while the state would have to pay $27 million over the next seven years to expand Medicaid, it will also increase state revenue through the Medicaid Enhancement Tax and Insurance Premium Tax.

The expansion will also reduce the cost of uncompensated care that hospitals, community health and mental health centers provide and the state partially pays, she said.

“Under the managed care model, there is the high probability that Medicaid expansion will not cost the state anything,” Dunn said.

Senate Finance Chairman Sen. Chuck Morse, R-Salem, said the $2.5 billion coming into the state has to be produced somewhere. He wondered how much New Hampshire residents and businesses pay in federal taxes.

“Is there a better way for New Hampshire to do this?” he asked, questioning if the state could do some kind of self-contained program.

Senate Minority Leader Sylvia Larsen, D-Concord, said the state would get $2.5 billion and save millions in other areas, noting financially Medicaid expansion would be a good deal for the state.

Republican senators also questioned if managed care and Medicaid expansion should be linked as Dunn and Toumpas said.

When Medicaid managed care was approved, Morse said, there was never any mention of expanding Medicaid.

But Toumpas said when managed care was being discussed, states did not have an option they had to expand Medicaid under the ACA. The U.S. Supreme Court decision allows states to decide if they want to expand the program, he said.

The Senate Finance Committee expects to begin deciding on its version on the two-year operating budget next week and have it finalized before the June 6 deadline to act on all bills.